Abortion

2019 ◽  
Author(s):  
Nisha Verma ◽  
Siripanth Nippita
Keyword(s):  
Pregnancy Termination ◽  
Healthcare Providers ◽  
Medical Abortion ◽  
First Trimester ◽  
The United States ◽  
Decision Making Process ◽  
Basic Information ◽  
Second Trimester ◽  
Dilation And Curettage ◽  
Cervical Preparation

Individuals may have a variety of reasons to end a pregnancy. Healthcare providers should provide support during the decision-making process and should be able to give patients basic information about their options depending on gestational age. In the United States, clinicians can offer first-trimester medical abortion with mifepristone and misoprostol up to 10 weeks’ gestation. Uterine aspiration or dilation and curettage are options throughout the first trimester. Options in the second trimester include induction abortion with medications, or a surgical procedure (dilation and evacuation) which may require cervical preparation at later gestational ages. Clinicians should assess the patient’s desire for fertility following an abortion and may offer contraception or preconception advice, as appropriate. This review contains 13 figures, 6 tables, and 61 references. Key Words: abortion, dilation and curettage, dilation and evacuation, mifepristone, misoprostol, pregnancy termination

DEGLOVING BOWEL INJURY FOLLOWING SECOND TRIMESTER PREGNANCY TERMINATION IN THE ERA OF MODERN OBSTETRICS: A CASE REPORT

2021 ◽  
pp. 5-6
Author(s):  
Shree Bharathi ◽  
Deepthi Nayak ◽  
Vinodhini Kadir ◽  
Niveditha Jha ◽  
Haritha Sagili
Keyword(s):  
Pregnancy Termination ◽  
Rare Complication ◽  
Medical Abortion ◽  
Bowel Injury ◽  
Second Trimester ◽  
Fetal Head ◽  
Trimester Abortion ◽  
Mortality And Morbidity ◽  
Breech Delivery ◽  
Degloving Injury

Degloving injury to the bowel following uterine instrumentation is a rare complication of second trimester abortion. Unsafe abortion practices can lead to such complications adding on the maternal mortality and morbidity. Here we present a case of 19-year-old unmarried girl who had undergone medical abortion and sustained decapitation of the fetal head during breech delivery which necessitated instrumentation for its retrieval leading to perforation and degloving bowel injury

scholarly journals Effectiveness of misoprostol for induction of first and early second trimester spontaneous miscarriages in parous women

2018 ◽  
Vol 7 (11) ◽  
pp. 4512
Author(s):  
Tamima Al-Dughaishi ◽  
Amjad Hamed Al-Haddabi ◽  
Mussab Mussab Mubarak Hamed Al-Jabri ◽  
Vaidyanathan Gowri
Keyword(s):  
Success Rate ◽  
First Trimester ◽  
University Hospital ◽  
Second Trimester ◽  
Sultan Qaboos University ◽  
Dilatation And Curettage ◽  
Dilation And Curettage ◽  
Medical Termination ◽  
Surgical Evacuation ◽  
Incomplete Miscarriage

Background: Medical termination of missed miscarriage and incomplete miscarriage with misoprostol, are an alternative to surgical evacuation (dilatation and curettage). This study aimed to evaluate the effectiveness of misoprostol in highly parous woman for incomplete and missed miscarriage.Methods: This was a retrospective study was conducted in two different time lines (2010 and 2014). All patients admitted to the Sultan Qaboos University hospital, Muscat, Oman, for the management of first-trimester miscarriages (missed and incomplete types) during the study period were included. Some women were moved to dilation and curettage even after misoprostol. The effect of gravidity and parity on those women in whom misoprostol was not effective was studied.Results: The overall success rate of misoprostol for the management was 62.14% in 2010 and 53.8% 2014. In nulliparous woman the success rate of misoprostol was slightly higher than parous women. There was no apparent effect of gravidity and parity of ≥ 5 or ≥ 5 on the success of misoprostol.Conclusions: Misoprostol reduced the rate of surgical evacuation among the study subjects. In highly parous and multigravid women (≥ para 5 and gravida ≥5) the success was not significantly different compared to less parous women.

First-trimester medical abortion

2014 ◽  
Vol 63 (6) ◽  
pp. 66-86
Author(s):  
Gennadiy Tikhonovich Sukhikh ◽  
Vladimir Nikolaevich Serov ◽  
Vera Nikolaeva Prilepskaya ◽  
Natal'ya Eknikovna Khan ◽  
Viktor Leonidovich Tutunnik ◽  
...  
Keyword(s):  
Russian Federation ◽  
Work Group ◽  
Pregnancy Termination ◽  
Medical Abortion ◽  
First Trimester ◽  
Cochrane Library ◽  
Clinical Protocol ◽  
Safe Abortion ◽  
The Russian Federation ◽  
The Cochrane Library

The Clinical Protocol “First-Trimester Medical Abortion” is written in accordance with the Russian laws on health protection, Procedure on medical care provision to women seeking for artificial termination of pregnancy, Law on drug circulation. The evidential base for the clinical protocol was constituted by the publications included in the Cochrane Library, PUBMED and MEDLINE databases, by the results of the Russian clinical studies on the medical abortion carried out with the permission of the Ethical Committee of the Ministry of Healthcare of the Russian Federation, by the Russian and international regulatory documents on safe abortion (FDA, HAS). The objective of these clinical protocol is to improve the quality of medical aid in the Russian Federation provided during early pregnancy termination. The comments were discussed jointly by the work group members; a consensus was reached on the key questions of the clinical protocol and practical recommendations were developed.

Buccal misoprostol as cervical preparation for second trimester pregnancy termination

Contraception ◽  
2002 ◽  
Vol 65 (6) ◽  
pp. 415-418 ◽  
Author(s):  
Catherine S. Todd ◽  
Maria Soler ◽  
Laura Castleman ◽  
M.Katherine Rogers ◽  
Paul D. Blumenthal
Keyword(s):  
Pregnancy Termination ◽  
Second Trimester ◽  
Trimester Pregnancy ◽  
Second Trimester Pregnancy ◽  
Cervical Preparation

scholarly journals A retrospective study of efficacy and cost efficiency of medical vs. surgical management of abortions in first trimester

2021 ◽  
Vol 10 (9) ◽  
pp. 3429
Author(s):  
Meetangi Agarwal ◽  
Sailatha Ramanujam ◽  
Anuradha C. Ramachandran
Keyword(s):  
Success Rate ◽  
Pregnancy Termination ◽  
Transvaginal Ultrasound ◽  
Cost Effective ◽  
Medical Abortion ◽  
First Trimester ◽  
Observational Research ◽  
Medical Termination ◽  
Significant Difference

Background: The aim of the study was to assess and comparatively evaluate the efficacy of different methods of first trimester abortions (medical, surgical) in terms of its safety, cost and effectiveness.Methods: We present a retrospective observational research study done at Chettinad hospital and research institute, Kelambakkam Chennai which included a total of 70 patients of first trimester abortions, in the period from June 2019 to June 2020. 55 patients were offered medical treatment (MTOP) and were followed up with a repeat scan after 2 weeks. In cases of failed medical abortion patient underwent curettage. Though, in some cases after an attempt at medical abortion, if the products didn’t expel at all within 48 hours, dilatation and evacuation was offered. Transvaginal ultrasound was performed to confirm the success of the treatment. In 15 cases who presented with incomplete abortion, surgical treatment (STOP) was offered. The outcomes considered were successful complete abortions, failed medical abortions, side effects and complications including blood transfusion.Results: The baseline characteristics of women were similar in both the groups like mean age, parity, history of previous termination of pregnancy (TOP). The success rate in MTOP was 67.2% and in STOP 100%.The amount of bleeding experienced was moderate to heavy in MTOP and minimal to moderate in STOP.37 women who underwent only medical termination who returned for the 2-week follow-up, the rate of complete pregnancy termination was 94% and for the remaining 2 women surgical intervention was required. In the surgical group, at the 2-week follow up, no woman underwent a repeat vacuum aspiration with an efficacy of 100%. No significant difference was found in the mean total cost for the medical and surgical groups after adding the subsequent costs (including additional manual vacuum evacuation).Conclusions: Medical termination of abortion should be preferred over surgical termination as it is safer, cost effective, with fewer complications and high success rate. 

scholarly journals Abortion Provision Among Recently Graduated Family Physicians

2020 ◽  
Vol 52 (10) ◽  
pp. 724-729
Author(s):  
Payal Patel ◽  
Sumathi Narayana ◽  
Aleza Summit ◽  
Marji Gold ◽  
Zachary J. Morgan ◽  
...  
Keyword(s):  
Pregnancy Termination ◽  
Academic Medical Center ◽  
Family Physicians ◽  
The United States ◽  
Early Career ◽  
Future Research ◽  
The West ◽  
Dilation And Curettage ◽  
Geographic Regions ◽  
Abortion Access

Background and Objectives: Family physicians (FPs) are well positioned to increase abortion access given their broad scope and diverse geographic practice regions. Previously published studies focus on physicians who received formal abortion training but do not include the full landscape of FPs performing abortions in the United States. This secondary data analysis presents a unique opportunity to examine characteristics of early-career FPs who provide abortions, including practice locations and if they received abortion training during residency. Methods: We analyzed data from the 2016-2018 Family Medicine National Graduate Survey to generate descriptive statistics about respondents who report providing pregnancy termination, uterine aspiration/dilation and curettage, or both. We evaluated associations between physician and/or practice characteristics and providing pregnancy termination using bivariate statistics. Results: Of the 6,319 survey respondents, 3% reported providing pregnancy termination. Nearly three-quarters of this subset reported graduating residency feeling prepared to provide pregnancy termination. Most respondents completed residency in the West or Northeast US geographic regions, and 3 years later were practicing in the West or South regions. Additional characteristics associated with providing pregnancy termination include female gender, providing continuity care, and practicing in either an academic medical center or a federally qualified health center. Conclusions: FPs are well positioned to address gaps in abortion access, and those who provide pregnancy termination practice in various US geographic regions. This is the first discussion of its kind about the scope of family physicians providing abortion care. Future research should continue to characterize FPs who provide abortions to determine where they train and practice and what type of abortions they provide.

scholarly journals Utilisation of second-trimester spontaneous and induced abortion services in public hospitals in Mexico, 2007–2015

2019 ◽  
Vol 45 (4) ◽  
pp. 283-289 ◽  
Author(s):  
Lily T Alexander ◽  
Evelyn Fuentes-Rivera ◽  
Biani Saavedra-Avendaño ◽  
Raffaela Schiavon ◽  
Noe Maldonado Rueda ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
State Level ◽  
Population Data ◽  
First Trimester ◽  
Public Hospitals ◽  
Second Trimester ◽  
Trimester Abortion ◽  
Discharge System ◽  
Abortion Law ◽  
Second Trimester Abortion

BackgroundData on utilisation of in-facility second-trimester abortion services are sparse. We describe temporal and geographical trends in utilisation of in-facility second-trimester abortion services across Mexico.MethodsWe used 2007–2015 data from Mexico’s Automated Hospital Discharge System (SAEH) to identify second-trimester abortive events (ICD O02-O08) in public hospitals across Mexico’s 32 states. We described utilisation, calculated rates using population data, and used logistic regression to identify woman- and state-level factors (municipality-level marginalisation, state-level abortion law) associated with utilisation of second-trimester versus first-trimester services.ResultsWe identified 145 956 second-trimester abortions, or 13.4% of total documented hospitalizations for abortion between 2007 to 2015. The annual utilisation rate of second-trimester abortion remained constant, between 0.5 to 0.6 per 1000 women aged 15–44 years. Women living in highly marginalised municipalities had 1.43 higher odds of utilising abortions services in their second versus their first trimester, when compared with women in municipalities with low marginalisation (95% CI 1.18 to 1.73). Living in a state with a health or fetal anomaly exception to abortion restrictions was not associated with higher utilisation of second-trimester abortion services.ConclusionsOur results suggest there is a need for all types of second-trimester abortion services in Mexico. To improve health outcomes for Mexican women, especially the most vulnerable, access to safe second-trimester abortion services must be ensured through the implementation of current legal exceptions and renewed attention to the training of healthcare providers.

scholarly journals Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

2013 ◽  
Vol 137 (3) ◽  
pp. 326-337 ◽  
Author(s):  
Linda M. Ernst ◽  
Lori Gawron ◽  
Michael K. Fritsch
Keyword(s):  
Pregnancy Termination ◽  
Placental Tissue ◽  
The United States ◽  
Legal Issues ◽  
Surgical Pathology ◽  
Second Trimester ◽  
Pathologic Examination ◽  
Fetal Demise ◽  
Intrauterine Fetal Demise ◽  
Clinical Diagnoses

Context.—Dilation and evacuation (D&E) is an alternative method to induction of labor for pregnancy termination and intrauterine fetal demise, and it is the most common mode of second-trimester uterine evacuation in the United States. Many D&E specimens are examined in surgical pathology, and there is little information available in surgical pathology textbooks or the literature to assist pathologists in these examinations. Objective.—To provide an overview of the D&E procedure, discuss related legal issues, provide guidelines for routine pathologic examination of D&E specimens, and demonstrate the importance of careful pathologic examination of D&E specimens. Data Sources.—Case-derived material and literature review. Conclusions.—Pathologic examination of D&E specimens has been understudied. However, the available literature and our experience support the fact that careful pathologic examination of D&E specimens can identify significant fetal and placental changes that can confirm clinical diagnoses or provide definitive diagnosis, assist in explaining the cause of intrauterine fetal demise, and identify unexpected anomalies that may provide further clues to a diagnostic syndrome or mechanism of anomaly formation.

Prenatal serum screening for Down syndrome and neural tube defects in the United States: Changes in utilization patterns from 2012 to 2020

2021 ◽  
pp. 096914132110316
Author(s):  
Nathalie Lepage ◽  
Philip Wyatt ◽  
Edward R Ashwood ◽  
Robert G Best ◽  
Thomas Long ◽  
...  
Keyword(s):  
United States ◽  
Down Syndrome ◽  
First Trimester ◽  
The United States ◽  
Maternal Serum ◽  
Second Trimester ◽  
Maternal Serum Screening ◽  
Cell Free Dna ◽  
Free Dna ◽  
Serum Screening

Objective To compile current usage of serum-based prenatal screening for Down syndrome in the United States and compare it with results from a similar 2011/2012 survey. Setting The College of American Pathologists maternal screening proficiency testing survey includes a supplemental question on the first of three yearly distributions. Methods Information regarding tests offered and the monthly number of pregnancies tested for US-based laboratories were reviewed. Results were stratified by size of laboratory, tests offered, and pregnancies tested. Findings were compared to an earlier survey. Results Fifty-six laboratories reported they will have screened 1,131,336 pregnancies in 2020. Of these, 36% are screened by stand-alone first trimester testing, 48% by stand-alone second trimester testing, and 16% using tests that integrate results from both trimesters. Eighty percent of all serum screens were provided by the five laboratories that performed the most screens (at least 50,000). These five performed similar proportions of first or second trimester screens (42.2% and 41.8%, respectively). Compared to eight years earlier, there are now 54% fewer laboratories. Pregnancies screened using the first trimester, second trimester, and integrated protocols were lower by 27%, 69%, and 72%, respectively. The serum screening activity in the US showed a 62% decrease from 2012 levels. During 2012–2020, the number of cell-free DNA tests increased from negligible to 1,492,332. Conclusions Maternal serum screening for common aneuploidies has changed significantly in eight years with fewer laboratories, a shift toward larger laboratories and a 2.5-fold reduction in pregnancies tested, likely due to the introduction of cell-free DNA screening.

scholarly journals Randomized comparison of vaginal and sublingual misoprostol with mifepristone priming in termination of second trimester pregnancy

2019 ◽  
Vol 7 (10) ◽  
pp. 3869
Author(s):  
Shrikrushna Vasant Chavan ◽  
Niraj Nilkanth Mahajan ◽  
Arundhati Gundu Tilve
Keyword(s):  
Side Effects ◽  
Pregnancy Termination ◽  
Medical Abortion ◽  
P Value ◽  
Second Trimester ◽  
Open Label ◽  
Sublingual Misoprostol ◽  
Group A ◽  
Vaginal Misoprostol ◽  
Group B

Background: Sublingual Misoprostol 200 ug 4 hrly is as effective or less effective than vaginal Misoprostol 200ug 4hrly with 200mg oral Mifepristone in termination of second trimester pregnancy.To compare effectiveness, side-effects, and patient satisfaction of sublingual vs vaginal misoprostol administration.Methods: It was prospective randomized open label study. 60 women 13-20 weeks of gestation with a valid legal indication for termination of pregnancy as per MTP act in INDIA were enrolled for study, randomly divided into Group A- Sublingual (n=30) group B-Vaginal (n=30). For group A, 200 mg of Mifepristone was given, 48h later Misoprostol 200 µg was given sublingually 4hrly up to a maximum of 5 doses. If abortion does not occur, the pregnancy was terminated with vaginal misoprostol, in group A. Same procedure repeated in group B. If abortion fails to occur after 5 doses, then second course of vaginal misoprostol was given in group B. Failure of procedure was defined as failed expulsion of foetus at 48 hrs. Results: Mean induction-abortion interval in vaginal group was 12.8±4.38h and 11.47±4.42h in sublingual group was comparable with insignificant p value (p=0.136). All the side effects were comparable in both groups. The overall success rate was 93.3% in the sublingual group while it was 100% in the vaginal group.Conclusion: Vaginal misoprostol with oral mifepristone priming in second -trimester medical abortion has a shorter time to pregnancy termination compared with a sublingual regimen. However, both the routes are equally effective for induction of abortion.

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